World Journal of Plastic Surgery
Year:2025 | Volume:14 | Issue:2|Papers Count:15

Background: Bell's palsy is an acute, asymmetrical paralysis of facial muscles resulting from peripheral facial nerve dysfunction without a discernible origin. Combination therapy, which leverages the benefits of both antivirals and steroids, may be an effective treatment for Bell's palsy. We aimed to evaluate the effectiveness of steroids antiviral treatments for facial paralysis. Methods: A systematic search was conducted using the Scopus, PubMed, and Web of Science databases. The search terms used were: (Bell's palsy OR facial palsy) AND (steroids OR corticosteroids) AND antiviral. All selected articles were published between 1990 and Jan 2023. Comprehensive Meta-Analysis (CMA) version 3 was used for statistical analysis and graph construction. Results: After a full-text evaluation, 14 studies were included. The comparison of patient outcomes between the two treatment groups indicated that combination therapy was more effective than single therapy. Famciclovir, valacyclovir, and acyclovir, respectively, showed the most significant synergistic effect with corticosteroids. According to Egger's test, no significant bias was found in the comparison of the two treatment groups. Conclusion: Combination therapy (corticosteroid and antiviral) is significantly more effective than single corticosteroid therapy. Among the antiviral agents, famciclovir, valacyclovir, and acyclovir demonstrated the highest efficacy in combination with corticosteroids.

Background: Adjuvant-induced autoimmune syndrome (ASIA), described in 2011, includes autoimmune reactions triggered by environmental adjuvants, such as silicone breast implants (SBI). Symptoms include fatigue, sleep disturbances, appetite changes, muscle pain, fever, among others, with pathophysiology involving a combination of genetic predisposition and adjuvant exposure, leading to abnormal immune responses. We aimed to define clinical profiles and outcomes of patients with SBI, clarify ASIA's clinical implications, and guide future research. Methods: Using the PRISMA-ScR framework, a scoping review was conducted to identify clinical profiles, preexisting conditions, prosthetic anomalies, and outcomes of patients with ASIA syndrome associated with SBI. Searches were performed in Medline, Scopus, Lilacs, and Google Scholar to locate relevant studies. Results: Of 35 selected studies, 21 were case reports, 6 case series, and 8 cohort studies, identifying 848 patients, predominantly from the Netherlands (n=513), with an average age of 45-47 yr. Common medical histories included autoimmune diseases and breast cancer, while frequent implant-related anomalies were capsular contracture and rupture. Musculoskeletal symptoms and fatigue were the most prevalent, and implant explantation was the primary treatment, resulting in symptom improvement for most patients. Conclusion: This review highlights the clinical features of ASIA syndrome in patients with SBI, particularly musculoskeletal symptoms, fatigue, and the presence of positive antinuclear antibody as a potential marker. However, the relationship between SBI and ASIA remains controversial. Despite limitations in current evidence, ongoing clinical monitoring and further research are crucial to better understanding and managing ASIA syndrome in patients with SBI.

Background: Graphene oxide (GO) and reduced graphene oxide (rGO) are graphene-based nanomaterials (GBNs) gained a lot of interest in biomedical tissue engineering due to their large specific surface area, unique structure, excellent photo-thermal effect, pH response, and broad-spectrum antibacterial properties. We aimed to modify the properties of graphene oxide/polycaprolactone (GO/ PCL) scaffold by laser irradiation. Methods: The scaffold was fabricated by electrospinning method and then laser irradiation was applied to improve the scaffold's properties. The solution containing of PCL and graphene oxide was combined in an optimized ratio and then transferred to an electrospinning syringe. The temperature distribution affected by laser energy on a scaffold was predicted by heat equation. The Crank-Nicholson numerical method in two dimensions was used in this regard. The morphological properties were evaluated by SEM, XRD, and IDFIX. MTT assay was applied for biocompatibility evaluation. Results: The 808 nm wavelength and 800 mW power was ideal laser irradiation. SEM results showed the appropriateness of fibres.  MTT results showed a significantly higher cell viability in PCL/rGO group compared to PCL/GO and PCL scaffolds (p≤0.001). Conclusion: The conversion of GO into rGO led to the better morphology and the reduction of cytotoxicity that gave the scaffold superior properties. Hence, it is justifiable to construct a composite scaffold, enhanced with rGO, to improve its conductivity, mechanical properties, and biocompatibility in the context of tissue engineering.

Background: Bilateral sagittal split osteotomy (BSSO) is the most common procedure in orthognathic Surgey of mandible also in asymmetries. However, the methods of fixation are different. Few studies worked on asymmetric cases especially with the use of finite element analysis (FEA). We aimed to evaluate stress distribution of two different Fixation techniques in mandibular setback surgery in asymmetric cases using FEA. Methods: A 3-dimensional model of asymmetric mandible was obtained. SSRO with modified osteotomy was simulated unilaterally and another side osteotomized as common .Then differential set back was done and rigid fixation of that modified side with miniplate and monocortical screws was simulated then rigid fixation of other side by different fixation technics include 2 or 3 bicortical screws. With the force of 132N and 300N on the occlusal surface of first molars, the Von Mises Stress (VMS) distribution was calculated. Results: Stress distribution in threads of screws in use of three bicortical screws was higher than two bicortical screws (161%). VMS distribution in spongy bone of left ramus in use of three bicortical screws was higher than the use of two bicortical screws (78% difference). VMS distribution in cortical bone of mandible body in use of three bicortical screws was significantly higher than the use of two bicortical screws (1.3% difference) (P<0.5). Conclusion: The use of modified osteotomy and fixation with rigid fixation of two bicortical screws can create a more predictable and uniform stress distribution in mandibular setback surgery in asymmetric cases.

Abstract We aimed to review the clinical approach to diagnos and surgical management of traumatic extraocular rectus muscle disruptions, a rare but significant cause of strabismus and diplopia in the adult trauma patients. This review examined the anatomy of the four rectus muscles, mechanisms of injury, clinical presentation, imaging evaluation, classification of injury types, management strategies, outcomes, and future directions in treatment. Extraocular rectus muscle disruptions occur through blunt trauma (typically causing muscle entrapment in the orbital fractures) or penetrating trauma (causing laceration or avulsion). Clinical features include diplopia, restricted eye movement, and in some cases, visible muscle prolapse. Imaging evaluation includes computed tomographyas first-line approach, with magnetic resonance imaging providing superior soft tissue detail, and anterior segment optical coherence tomography offering valuable information for surgical planning. Management focuses on early intervention, with surgical repair ideally performed within 24-48 hours for entrapped muscles and within days for lacerations or avulsions. Outcomes vary based on injury severity and timing of treatment, with better prognosis associated with early intervention. While traumatic extraocular rectus muscle disruptions present complex challenges, prompt diagnosis and surgical management often yield favorable results. Future advances in treatment might involve advanced imaging techniques, engineered tissue for muscle reconstruction, refined surgical approaches, and improved interdisciplinary trauma care protocols.

Background: Retrorectal tumors are rare, heterogeneous neoplasms in the pararectal space that have low incidence, nonspecific symptoms, and variable presentations; they are often challenging to diagnose and manage, necessitating high clinical suspicion. We evaluated the clinical characteristics, diagnostic challenges, surgical outcomes, and postoperative follow-up of patients with retrorectal tumors treated over 12 years. Methods: A retrospective case series was conducted on 34 patients who underwent surgery for retrorectal tumors at Taleghani Hospital, Tehran, Iran, from 2011 to 2023. Clinical presentations, imaging findings, surgical interventions, histopathological diagnoses, and postoperative outcomes were analyzed. Results: Thirty-four patients with 37 lesions were included, with a mean age of 40.21 ± 11.57 years. The majority of patients were female (88.2%). Pelvic pain was the most common symptom (44.1%), followed by rectal pain (38.2%). The retrorectal space was the most frequently affected location (67.6%). Most tumors were cystic (51.4%), with congenital tumors being the most common histopathological subtype (37.8%). Malignancy was identified in 29.7% of cases. The most frequent surgical approach was total resection via the posterior approach (55.9%), followed by the anterior approach (26.5%). Postoperative recurrence requiring secondary surgery was observed in 5.9% of patients. Conclusion: Due to their rarity and diverse presentations, retrorectal tumors pose significant diagnostic and surgical challenges. Preoperative imaging plays a critical role in diagnosis and surgical planning. Complete surgical excision remains the mainstay of treatment, and recurrence is rare. Multidisciplinary collaboration is essential for optimizing patient outcomes.

Background: Diabetes mellitus is related to wound healing process impairments and molecular abnormalities of the wound. We aimed to evaluate the therapeutic potential of semi-solid bone marrow as a source of stem cells (SCs) in regenerative medicine. Methods: This trial study was conducted at the Faculty of Medicine, Lorestan University of Medical Sciences, Khorram Abad, IRAN in 2019. Forty five Albino Wistar rats with an average weight of 250–300g, were purchased from Lorestan Aftabavaran Company in (Khorramabad, Lorestan, Iran). The rats were divided into 3 groups (n=15). For all groups, Streptozotocin (STZ) (Single dosage; 65 mg/kg, i.p.) was used to induce diabetes, and Sharp dissection was used to draw and pull down a dorsal skin flap (9×3 cm) in the control and saline groups on day0, respectively. The group used 7 × 109 BMMSCs on day 0. Histologic specimens were stained with hematoxylin and eosin and were stained with trichrome mason. Biomechanic measurements were taken in the wound area, Results: The epidermal thickness was increasing and blood vessels were growing. In the cells group, hair follicle destruction, cellular penetration, diffuse fibrosis, and necrosis were not observed in comparison with the saline and control groups. The Cells group had a higher energy absorption than the Bending stiffness and Maximal Force Ultimate Tensile Strength (UTS) group on day 14 as a result of decreased Bending stiffness and Maximal Force Ultimate Tensile Strength (UTS). Conclusion: According on result of recent study, Stem cells can improve the healing of diabetic incision wounds.

Background: Alveolar osteitis (AO), commonly known as dry socket, is a recognized complication following tooth extraction, particularly prevalent after mandibular third molar extractions. Given the global pandemic of coronavirus disease (COVID-19) and its implications for endothelial and hematologic changes, investigating its potential impact on dry socket risk in patients undergoing mandibular third molar extraction is crucial. Methods: We reviewed patient records from individuals undergoing mandibular third molar extraction at Mashhad Dental School, Mashhad, Iran in 2022. Data included demographics, medical history, smoking status, and COVID-19 details such as history, hospitalization, and vaccination status. Results: Clinical examinations diagnosed alveolar osteitis, assessing for blood clot presence and local lymphadenitis. Out of 119 patients (82 females, 37 males), 49.6% developed dry socket post-extraction, with 94.1% having a history of COVID-19 and 32.7% requiring hospitalization due to the disease. 97.5% of patients were vaccinated against COVID-19. Additionally, 44.5% had systemic disease history, and 45.4% used related medications, with no observed associations with dry socket. Conclusion: This study underscores the increased risk of dry socket following mandibular third molar extraction associated with corticosteroid use, oral contraceptive use, smoking, and COVID-19 hospitalization. Females exhibited a significantly higher risk compared to males. While no significant COVID-19 infection-dry socket link was found, the study highlights the need for further research, given the significant number of dry socket cases among COVID-19 patients and those hospitalized due to COVID-19.

Background: Mucormycosis is a fungal infection with diverse clinical manifestations, the most common of which, i.e., the classical form of rhino-orbital cerebral mucormycosis (ROCM), has had a significant prevalence among patients recovered from COVID-19. We aimed to investigate the findings of ROCM imaging recorded at Imam Khomeini Hospital in Ahvaz, Iran, in 2022. Methods: This retrospective study reviewed the files of patients definitively diagnosed with mucormycosis and COVID-19. Imaging procedures performed on patients included non-contrast CT scans (CT imaging protocol: from vertex to mandible without contrast for evaluating sinus contents, bone erosion, osteomyelitis, pre-sinus or orbital invasion). Key imaging findings were assessed and documented, and findings were evaluated. Results: The mean age of subjects was 53.11 ± 14 years, with the majority being male (55.3%). All subjects had nasal and sinus involvement, but their brains were unaffected. Approximately 36% of subjects had ocular involvement. In imaging findings, left pterygopalatine involvement had the highest prevalence (27.7%), while left extraocular muscle involvement had the lowest prevalence (4.3%). Patients with lamina papyracea and extraocular muscle involvement all had ocular involvement, which was statistically significant. Additionally, those with hard palate erosion had significantly higher ocular involvement rates (5 out of 6 cases with hard palate erosion). Conclusion: Rhino-orbital cerebral mucormycosis is associated with nasal and sinus involvement, and diabetes and male gender are predisposing factors to this disease. CT, as a complement to other clinical evaluations, dramatically aids in diagnosing and identifying the extent and complications of the disease.

Background: Cleft lip in infants is associated with severe morphological and functional disorders. Cleft lip is particularly important, which can lead to psychological changes in the patient if the treatment result is not satisfactory. Different surgical methods have been developed in the past decades. We aimed to investigating cleft lip techniques and surgical outcome in patients. Methods: In this cross-sectional analytical study, 32 patients undergoing cleft lip surgery referred to Abuzar Children's Hospital in Ahvaz, southern Iran between 2022 and 2023 were enrolled. According to the surgeon's opinion, the patients underwent cleft lip surgery using the Sommerlad technique. (n=18 or Millard technique (n=14). Surgical Ooutcomes were compared between the two groups. Results: The mean age was 33.58±59.14 months. 65.6% of patients were boys (n=21). The need for rhinoplasty in the Sommerlad and Millard groups was 100% and 84.6%, respectively, and no significant difference was observed between the two groups (P=0.17). The cupids bow was estimated to be good in 28.6% and 38.9% of  patients in the Millard and Sommerlad groups, respectively, while this difference between the two groups was not significant (P=0.51). There was no significant difference between the two groups in the vermilion border (P=0.31). No significant difference was observed between the two groups in terms of white roll match, lip length and Scar appearance (P>0.05). Conclusion: No significant difference was observed in the results of lip surgery between the Sommerlad and Millard techniques. Further multicenter studies with larger sample sizes are recommended to validate these results.

Background: One of the most important stages in rhinoplasty is the control of nasal tip rotation. Different techniques have been proposed to achieve this goal. We aimed to compare the effects of two methods of Septocolumellar Suture (SCS) and Lateral Crural Overlay (LCO) on nasal tip rotation by measuring of Columella-Labial angle. Methods: In a single-blinded clinical trial, 148 patients were selected among the patients who were candidates for rhinoplasty in Sina Hospital in Tehran, Iran 2024. The patients were randomly divided into two groups (each group contained 74 subjects). The patients in the first group were operated on using LCO technique, and the patients in the second group were operated on using SCS technique. Columella-Labial angle of the samples were evaluated using the photographs of the samples before and six months after surgery. The obtained results were compared using SPSS software and t-paired and Mann-Whitney statistical tests. Results: The mean Columella-Labial angle in both groups was more than that before surgery (P<0.001). The mean Columella-Labial angle before surgery in the SCS group were higher than that in LCO group and this difference was significant (P<0.001). The Columella-Labial angle difference was also significant between the two groups after surgery (P = 0.005), and Columella-Labial angle in LCO group was higher than that in SCS group (P <0.001). Conclusion: LCO technique increase Columella-Labial angle more than SCS technique. Therefore, it is recommended that LCO technique to be used in patients with who need greater Columella-Labial angle change.

The chondrocutaneous sandwich of the external ear has a delicate and complicated design, making partial ear reconstruction a challenging task for plastic surgeons. In this study, 12 patients who had surgery utilizing the conchal rotational flap and grafting approach were monitored for 1 year after surgery. The upper third of ear deformities have been repaired using a cartilaginous composite flap. Following the procedure, a year later, there were no signs of a seroma, infection, hematoma, deformity, or flap ischemia. All patients had pleasing cosmetic outcomes. The findings of this study suggest that full-thickness upper third auricular abnormalities be repaired utilizing this combination method.

Background: We aimed to create focus and awareness about versality of keystone flap in safe re-surfacing of small to medium and large sized skin defects in single stage with minimal donor site morbidities and maximum anatomical, functional and aesthetic results. Methods: Retrospective study was conducted between October 2021– December 2022 on 26 males and 5 females aged 20-70 years who underwent 32 Keystone flap reconstruction (type IIA n=11, type IIB n=7 type III n=6, Type IV n=8) in diversity of defects following: domestic electric burn on pulp of thumb (n=2), chronic discharging sinus over clavicle (n=1), post-traumatic wounds on eighteen legs (n=19), excision of unstable scar over shin of tibia (n=4), exit wound on medial aspect of foot (n=3) and excision of non-healing ulcer over heel (n=3). Flaps were designed in a way to keep maximum perforators in pedicular area and to ascertain maximum mobility. After debridement, wound area ranged from 4mm x 4mm to 17 x 8 cm. The flap size ranged from 5mm x 5mm to 18cm x 8cm. Follow- ups ranged from 1 month to 12 months. Results: Three cases developed partial wound dehiscence which were managed subsequently. None of the flap had partial or total loss. Over-all results were satisfying. Conclusion: Our series highlighted that keystone flaps have defect adaptive design and are technically easy to perform, cost and time effective and can be designed from head to toe (omnipresence) with excellent outcome. We advocate their use as robust reconstructive tool for Plastic surgeons, Orthopedic surgeons and Dermatosurgeon.

Background: The Altemeier procedure for rectal prolapse offers excellent results in all age groups with minimal complications and allows for short hospital stays and recovery periods. We aimed to evaluate the results of transperineal surgery for rectal prolapse. Methods: In this case series study, 74 patients underwent perineal rectal prolapse surgery using Altemeier method and coloanal anastomosis at Ayottollah Taleghani Hospital, Tehran from 2013 to 2023 were enrolled.  Results: Overall, 48 ​​patients were female (64.8%) and the mean age was 52 years (range 18 to 80). Common symptoms were constipation (62.1%), fecal incontinence (76.95%), rectal bleeding (41.85%), and difficult defecation (9.45%). The Jorge and Wexner incontinence score before and after the operation was 13.5 and 5.5, respectively, and no statistically significant difference was observed (P=0.41). No mortality was reported after surgery. Conclusion: The long-term recurrence rate after Altemier's procedure was low. This method has a reasonable recurrence rate compared to other techniques, and is a good option for younger patients without underlying disease. Further multicenter studies with larger sample sizes are needed to evaluate the outcomes of transperineal surgery for rectal prolapse.

Syndactyly is a common inherited and clinically heterogeneous malformation which can be syndromic or non-syndromic. It also varies phenotypically between the families. In this study, we present twins who experienced bilateral syndactyly and underwent reconstruction using the Gilbert method. These female twin toddlers were referred to Hazrat Fatemeh Clinic of Hand Surgery in Tehran, Iran, in 2022 with bilateral syndactyly of the middle and ring fingers. In both, fingers were fused along their entire length. One of them underwent the separation of the middle finger and ring finger of the right hand by the Jibert method, and the other underwent surgery for the separation of her left hand at the age of one and a half. She was presented with a contracture of the middle finger and third web space, corrected with a Z-plasty of the middle finger and the V-M flap for the web space.